Licensed and Liable. Insurance, Road Regulations, and Driving After Hip and Knee Arthroplasty Surgery

Published:October 20, 2022DOI:



      There is a reliance on surgeons to provide advice to patients regarding safe return to driving following hip or knee arthroplasty. Concerns arise that misinformation may place the surgeon in a position of potential legal implication. The purpose of this article is to inform surgeons of their role in accordance with advice from insurance companies and transport regulatory bodies.


      We sought the stipulations from 5 of the top 10 insurance companies in the United States, Canada, Australia, and the United Kingdom and the transport regulatory body of each country with regards to guidelines on driving after arthroplasty surgery.


      The transport regulatory bodies of the countries evaluated do not provide explicit recommendations regarding return to driving after hip or knee arthroplasty and place the responsibility of determining fitness to drive on the treating doctor. Insurance company policies do not contain specifics pertaining to driving after surgery and in most cases defer to the treating doctor to make this decision. Guidelines are available in Canada and America with suggested timeframes on return to driving following arthroplasty surgery.


      Advice regarding return to driving following hip or knee arthroplasty should be individualized for each patient; ultimately the patient must feel safe to drive knowing that they have a legal responsibility to remain in control of the vehicle at all times. It is recommended that surgeons document any discussion regarding return to driving and should not feel that they are contravening any prescriptive regulation by allowing driving when appropriate.


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        • Haverkamp D.
        • Rossen N.N.
        • Maas A.J.
        • Olsman J.G.
        Resuming driving after a fracture of the lower extremity: a survey among Dutch (orthopaedic) surgeons.
        Injury. 2005; 36: 1365-1370
        • Von Arx O.A.
        • Langdown A.J.
        • Brooks R.A.
        • Woods D.A.
        Driving whilst plastered: is it safe, is it legal? A survey of advice to patients given by orthopaedic surgeons, insurance companies and the police.
        Injury. 2004; 35: 883-887
        • MacLeod K.
        • Lingham A.
        • Chatha H.
        • Lewis J.
        • Parkes A.
        • Grange S.
        • et al.
        “When can I return to driving?”: a review of the current literature on returning to driving after lower limb injury or arthroplasty.
        Bone Joint J. 2013; 95-B: 290-294
        • Kirschbaum S.
        • Fuchs M.
        • Otto M.
        • Gwinner C.
        • Perka C.
        • Sentürk U.
        • et al.
        Reaction time and brake pedal force after total knee replacement: timeframe for return to car driving.
        Knee Surg Sports Traumatol Arthrosc. 2021; 29: 3213-3220
        • Dobbs B.M.
        Medical conditions and driving: a review of the scientific literature (1960 - 2000).
        US Department of Transportation, Washington, DC2005 ([accessed 15.03.22])
      1. Pomidor A. Clinician’s guide to assessing and counseling older drivers. The American Geriatrics Society, Washington, DC2019 ([accessed 15.03.22])
        • Wang C.C.K.C.
        • Schwartzberg J.G.
        • Shanklin A.V.
        Physician’s guide to assessing and counselling older drivers.
        National Highway Traffic Safety Administration, Washington, DC2003 ([accessed 15.07.22])
        • Canadian Council of Motor Transport Administrators
        National safety code, standard 6: driver fitness in Canada.
        CCMTA, Ottawa, Ontario2021 ([accessed 15.03.22])
        • Canadian Medical Association CM
        1st ed. CMA Driver’s Guide: determining medical fitness to operate motor vehicles. 9. Joule Inc, Ottawa, Ontario2019 ([accessed 15.03.22])
        • Austroads and the National Transport Commission
        Assessing fitness to drive for commercial and private vehicle drivers austroads Ltd.
        ([accessed 15.07.22])
        • UK Driver & Vehicle Licensing Agency
        Assessing fitness to drive - a guide for medical professionals.
        DVLA, Swansea2021 ([accessed 15.03.22])
        • Frane N.
        • Bandovic I.
        • Hu V.
        • Bitterman A.
        Return-to-driving recommendations after lower-extremity orthopaedic procedures.
        JBJS Rev. 2020; 8: e2000066
        • Rod Fleury T.
        • Favrat B.
        • Belaieff W.
        • Hoffmeyer P.
        Resuming motor vehicle driving following orthopaedic surgery or limb trauma.
        Swiss Med Wkly. 2012; 142: w13716
        • DiSilvestro K.J.
        • Santoro A.J.
        • Tjoumakaris F.P.
        • Levicoff E.A.
        • Freedman K.B.
        When can I drive after orthopaedic surgery? A systematic review.
        Clin Orthop Relat Res. 2016; 474: 2557-2570
        • Hau R.
        • Csongvay S.
        • Bartlett J.
        Driving reaction time after right knee arthroscopy.
        Knee Surg Sports Traumatol Arthrosc. 2000; 8: 89-92
        • Huang H.T.
        • Liang J.M.
        • Hung W.T.
        • Chen Y.Y.
        • Guo L.Y.
        • Wu W.L.
        Timeframe for return to driving for patients with minimally invasive knee arthroplasty is associated with knee performance on functional tests.
        BMC Musculoskelet Disord. 2014; 15: 198
        • Nguyen T.
        • Hau R.
        • Bartlett J.
        Driving reaction time before and after anterior cruciate ligament reconstruction.
        Knee Surg Sports Traumatol Arthrosc. 2000; 8: 226-230
        • Dugdale E.M.
        • Siljander M.P.
        • Trousdale R.T.
        Factors associated with early return to driving following total joint arthroplasty.
        J Arthroplasty. 2021; 36: 3392-3400
        • van der Velden C.A.
        • Tolk J.J.
        • Janssen R.P.A.
        • Reijman M.
        When is it safe to resume driving after total hip and total knee arthroplasty? a meta-analysis of literature on post-operative brake reaction times.
        Bone Joint J. 2017; 99-B: 566-576
        • Hartman J.
        • Thornley P.
        • Oreskovich S.
        • Adili A.
        • Bedi A.
        • Khan M.
        Braking time following total knee arthroplasty: a systematic review.
        J Arthroplasty. 2018; 33: 284-290.e281
        • Chen V.
        • Chacko A.T.
        • Costello F.V.
        • Desrosiers N.
        • Appleton P.
        • Rodriguez E.K.
        Driving after musculoskeletal injury. Addressing patient and surgeon concerns in an urban orthopaedic practice.
        J Bone Joint Surg Am. 2008; 90: 2791-2797